constitution draft 17 october 2012

7/30/2019 Constitution Draft 17 October 2012

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NHS CITY and HACKNEYCLINICAL COMMISSIONING GROUP

CONSTITUTION

Version: 0.17

Version control

version Date Author Changes Circulation0.1 June Paul Amendments to standard format Clare, Paul,0.2 July Paul Incorporation of LMV versions,

removal of unnecessary detail

Karl, Sue

0.3 & 0.4 26 July Karl After a review with Sue Assar,amendments made to somewording, format and order ofdetail

Clare/Paul to review prior towider circulation due toholiday this may go out toLMC and Greg Carns if nocomments received byMonday 30.07.12

0.5 30 July Matt Formatting Paul, Clare, LMC0.6 ? August Matt Amendment to wording Paul0.7 29 August Matt New content following latest

consultationPaul, Karl, Clare

0.8 13September

Matt Consultation changes accepted,SFIs updated

CCG, external consultation &legal advice

0.8 17September

Matt Updated following GoverningBody special session

0.991 18September

Karl Update following additionalreview by AO and advise fromsolicitor

Paul, LMC

.10 24 Sep. 12 Hempsons Paul, Karl, Matt

.11 26 Sep. 12 Hempsons Paul, Karl, Matt

.12 26 Sep. 12 Hempsons Paul, Karl, Matt, Clare

.13 26 Sep. 12 Karl Paul, Karl, Matt, Clare

.14 04 Oct. 12 Karl Amended based on additionalLMC feedback

Paul

.15 08 Oct 12 Hempsons Karl

.16 08 Oct 12 Karl Paul and Clare

.17 12 Oct Karl/Anna LMC feedback, Audit detail


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NHS City & Hackney Clinical Commissioning Groups Constitution - 1 - Version: [Insert No] | NHS Commissioning Governing Body Effective Date: [Insert Date]

CONTENTS

Part Description PageForeword

1 Introduction and Commencement1.1 Name1.2 Statutory framework1.3 Status of this Constitution1.4 Amendment and variation of this Constitution

2 Area Covered3 Membership

3.1 Membership of the CCG3.2 Eligibility

4 Mission, Values and Aims4.1 Mission4.2 Values4.3 Aims4.4 Principles of good governance4.5 Accountability

5 Functions and General Duties5.1 Functions5.2 General duties5.3 General financial duties5.4 Other relevant regulations, directions and documents

6 Decision Making: The Governing Structure6.1 Authority to act6.2 Scheme of reservation and delegation6.3 General6.4 Committees of the CCG6.5 Joint arrangements6.6 The Governing Body6.7 [insert name of committee established by the clinical

commissioning group]7 Roles and Responsibilities

7.1 Practice representatives7.2 Other GPs or primary care health professionals7.3 All members of the CCGs Governing Body7.4 The Chair of the Governing Body7.5 The deputy Chair of the Governing Body7.6 Role of the accountable officer7.7 Role of the chief finance officer

7.8 Joint appointments with other organisations8 Standards of Business Conduct and Managing Conflicts of Interest


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Part Description Page8.1 Standards of business conduct8.2 Conflicts of interest8.3 Declaring and registering interests

8.4 Managing conflicts of interest: general8.5 Managing conflicts of interest: contractors and people who provide

services to the CCG8.6 Transparency in procuring services

9 The CCG as Employer10 Transparency, Ways of Working and Standing Orders

10.1 General10.2 Standing orders

Appendix Description PageA Definitions of Key Descriptions used in this ConstitutionB List of Member and Consortium PracticesC Standing OrdersD Scheme of Reservation and DelegationE Prime Financial PoliciesF The Nolan PrinciplesG The Seven Key Principles of the NHS ConstitutionH Joint Arrangements


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FOREWORD

The Constitution sets out the arrangements made by NHS City and HackneyClinical Commissioning Group (CCG) to meet our responsibilities forcommissioning care for our patients and the principles we will operate by with our

partners. It describes the governing principles, rules and procedures that we willestablish to ensure probity and accountability in the day-to-day running of theCCG to ensure that decisions are made in an open and transparent way with theinterests of our patients and clinicians central to our goals and ambitions.

Who we serve

The City of London and Hackney face a significant health and wellbeingchallenge. Hackney is the second most deprived Borough in England andalthough the City of London has low levels of deprivation overall, there isconsiderable variation between wards, with Portsoken classified within the mostdeprived 20% of wards in the UK. In Hackney, male life expectancy is lower thanthe national average and female life expectancy varies by 4.6 years whencomparing the most and least deprived wards. In addition, there are a number ofpressing health needs in the area, including for example, high levels of childhoodobesity, prevalence of severe mental health conditions, late presentation forcancer and deaths from heart disease and stroke.

Our Hackney population is young and growing with a large turnover each year.The City population is ageing but is also characterised by the significant number ofcommuters travelling into the City each working day.

Who we are

Our CCG has grown from 2 highly successful clinical commissioning Consortiawho have been working together with our 44 practices since 2005 to improveservices for local people and have so far been successful in containing the rise incosts. We think this is the result of some excellent joint work with our providerclinicians across clinical pathways over the last five years, our joint commitment toimproving the quality and productivity of services and to doing whats best forpatients. Our pathways are widely used and audited across primary and

secondary care, helping to raise quality and increase efficiency.Our challenge

The next 3 years will be challenging for health services in City and Hackneybecause there is no longer growth money to cover increased costs, while ourpopulation faces an increase in poverty and chronic long term conditions, withrising unemployment and loss of welfare benefits. We expect increased ill healthand higher demand, including for mental health services. Our Joint StrategicNeeds Assessment details the local health challenges and we look forward toworking with our constituents and partners to address these, building on all our

work to date.


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1. INTRODUCTION

1.1. Name

1.1.1. The name of our Clinical Commissioning Group is NHS City and Hackney Clinical

Commissioning Group (CCG).

1.2. Statutory Framework

1.2.1. Our CCG is established under the 2006 Act 1. We are a statutory body which hasthe function of commissioning services for the purposes of the health service i n England and are treated as an NHS body for the purposes of the the 2006 Act 2.The duties of our CCG are to commission certain health services set out in section3 of the 2006 Act, as ame nded by section 13 of the 2012 Act, and the regulationsmade under that provision 3.

1.2.2. Our CCG will primarily be required to commission secondary care health serviceswithin the City of London and the London Borough of Hackney to:a) All patients registered with members who are GP practices (as per 3.2.1);b) Individuals who are resident within the City of London and the London

Borough of Hackney but not registered with members who are GP practices.

1.2.3. The NHS Commissioning Board (NCB) will undertake an annual assessment ofthe CCG 4. It has powers to intervene where it is satisfied that the CCG is failingor has failed to di s charge any of its functions or that there is a significant risk thatit will fail to do so 5.

1.2.4. We are a clinically led membership organisation made up of general practices.The members of our CCG are responsible for determining the governingarrangements for the CCG, which we are required to set out in this Constitution 6.

1.3. Status of this Constitution

1.3.1. This Constitution is made between the CCGs members of and has effect from[insert] day of [insert month] 20[insert year], when the NCB established the CCG 7.The Constitution is published on our website.

1.3.2. It is also available by post from; NHS City and Hackney CCG, Second Floor,Lawson Practice, Nuttall Street, London N1 5HZ.

1.4. Amendment and Variation of this Constitution

1 See section 1 I of the 2006 Act, inserted by section 10 of the 2012 Act 2 See section 275 of the 2006 Act, as amended by paragraph 140(2)(c) of Schedule 4 of the 2012 Act 3 Duties of clinical commissioning groups to commission certain health services are set out in section 3 of the2006 Act, as amended by section 13 of the 2012 Act 4 See section 14Z16 of the 2006 Act, inserted by section 26 of the 2012 Act 5 See sections 14Z21 and 14Z22 of the 2006 Act, inserted by section 26 of the 2012 Act 6

See in particular sections 14L, 14M, 14N and 14O of the 2006 Act, inserted by section 25 of the 2012 Actand Part 1 of Schedule 1A to the 2006 Act, inserted by Schedule 2 to the 2012 Act and any regulations issued 7 See section 14D of the 2006 Act, inserted by section 25 of the 2012 Act


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1.4.1. This Constitution can only be varied in two circumstances 8:a) Where our members and the Governing Body apply to the NCB and that

application is granted;b) Where in the circumstances set out in legislation the NCB varies our

Constitution other than on application by our members.

1.4.2. Any consortium representative, on behalf of their constituent members can call ameeting of the Members Forum to discuss changes and amendments to thisConstitution.

1.4.3. If 51% of those voting at a meeting of the Members Forum agree with the proposedamendments the Governing Body is bound by this decision and will apply to theNCB on behalf of members for the constitution to be amended.

8 See sections 14E and 14F of the 2006 Act, inserted by section 25 of the 2012 Act and any regulationsissued


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2. AREA COVERED

2.1. The geographical area (the Area) covered by NHS City & Hackney CCG is:a) The London Borough of Hackney;b) The City of London Corporation.


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3. MEMBERSHIP

3.1. Membership of the CCG

3.1.1. Appendix B of this Constitution lists the members of our CCG.

3.1.2. There are six consortia (each a consortium and together the consortia) beingSouth West Consortium, North West Consortium, North East Consortium, R&SConsortium, Well Consortium and Klear Consortium.

3.1.3. Each member shall belong to one of the CCGs six consortia as shown inAppendix B.

3.2. Eligibility

3.2.1. A body which is a provider of primary care services (holding a General MedicalServices (GMS), Personal Medical Services (PMS) or Alternative PersonalMedical Services (APMS) Contract) in the locality shall apply to become aMember of the CCG under the following conditions:a) If the provider holds a contract for the provision of primary medical services;b) It is a primary care services provider in City and Hackney;c) It has duly submitted an application to the NCB for membership to City and

Hackney CCG, such membership having been approved.

3.2.2. Once our CCG is established and an application is received from an eligibleprovider of primary care services as defined in 3.2.1, the Members Forum willask the Governing Body to apply to the NCB to amend the Constitution to admitthe proposed new member.

3.3. Each member shall nominate a practice representative to represent theirpractice's views and act on behalf of the practice in matters relating to the CCG.


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4. VISION, VALUES AND AIMS

4.1. What do we believe in?

4.1.1. We will transform the way services are delivered so that we can reduce health

inequalities for our patients at the same time as improving quality and access,aspiring to provide the best healthcare to those living in the City of London andHackney.

4.1.2. We want to ensure that our patients have easy access to a full range of serviceseach of which delivers a consistently high standard of patient experience andclinical outcome.

4.1.3. We will adopt a whole person approach to what we commission, integrating NHSand social services where this makes clinical and financial sense and commit tocommissioning and procuring services in a fair and ethical manner.

4.1.4. We will commission patient centred treatment and care that is grounded in dignityand mutual respect.

4.1.5. We will ensure that all our plans and decisions will benefit our patients and that allthe work we engage in will really make a difference.

4.1.6. We will work together to protect and continue the strengths, the ethos and thevalues on which the NHS was founded.

4.1.7. We will work with our member practices, external partners and providers and ourlocal communities to reduce health inequalities and improve quality for ourpatients.

4.1.8. We will play an active role in shaping, supporting and providing education both formembers of our CCG and more widely for the NHS and the health and social caresystem.

4.1.9. We will make our decisions and conduct our business in an open and transparentfashion.

4.1.10. We will work to ensure clinicians and patients are motivated and inspired by whatwe do, and so will want to get involved and really influence our thinking.

4.1.11. We will work to ensure that patient choice is not restricted by the way wecommission services and that different groups healthcare needs are consideredequally and fairly.

4.1.12. We will ensure sustainability principles are embedded across our commissionedservices thus preserving resources for future generations and ensuring publicmoney is spent in the most effective and sustainable way possible.

4.1.13. We will play an active role in supporting and stimulating research and in ensuringthat robust evidence from research is translated into clinical practice.


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4.2. How will we do this?

4.2.1. By creating a strong and equal partnership between our patients, public andclinicians, working in an open and transparent manner.

4.2.2. By operating in an open and democratic manner, with GP consortia and otherrepresentative groups electing their representatives and involving all interestedparties at all stages of our thinking and our decisions.

4.2.3. By committing to promoting and celebrating diversity and equality and tocombatting racism, homophobia, sexism, discrimination against people withdisabilities and similar behaviours and attitudes which undermine social cohesionand social justice.

4.2.4. By only commissioning services from providers who can demonstrate acommitment to their social responsibilities and to sustainability principles.

4.2.5. By working openly, transparently and extensively with our local providers toensure we can stay in financial balance.

4.2.6. By debating and declaring conflicts of interest and anything that might be viewedas a conflict openly to ensure that we do not undermine the trust of our patients.

4.2.7. By committing to involving the public, patients and our members in our decisions,consulting and testing out our plans and ideas via our website, formalconsultation, meetings and other appropriate routes.

4.2.8. By being receptive to all the feedback and views that we receive and explainingwhat we have done in response.

4.2.9. By publishing our Board papers and decisions in minutes on our website anddocumenting contract decisions in line with the Information Commissioners OfficeModel Publication Scheme.

4.2.10. By being transparent in the decisions we make and how we make them, makingas many decisions as possible in public and resisting being bound by conditions of

commercial confidentiality.4.2.11. By working with our Health and Wellbeing Boards (HWBs) and our patients,

clinicians and partners to ensure that we collectively address the needs identifiedin both the Joint Strategic Needs Assessment (JSNA) and those raised by ourpatients, clinicians and partners.

4.2.12. By continually challenging our assumptions and initiatives through robust review ofdata, clinical evidence, best practice, research, clinical audit, patient and clinicianviews and experiences, patient and clinical outcomes, quality measures andbenchmarked performance information.


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4.2.13. By working with and always considering the needs of City and Hackneys uniquecommunities and residents.

4.2.14. By working together with the public, patients, clinicians and local organisations,learning from and challenging each other and sharing ideas and best practice,

promoting a culture of constructive challenge.

4.2.15. By promoting good governance and proper stewardship of public money inpursuing our goals and meeting our statutory responsibilities.

4.3. Principles of Good Governance

4.3.1. In accordance with section 14L(2)(b) of the 2006 Act 9, we will at all times observesuch generally accepted principles of good governance in the way we conductour business. These include:a) The highest standards of propriety involving impartiality, integrity and

objectivity in relation to the stewardship of public funds, the management ofthe organisation and the conduct of its business;

b) The Good Governance Standard for Public Services 10 ;c) The standards of behaviour published by the Committee on Standards in

Public Life (1995) known as the Nolan Principles 11 ;d) The seven key princip les of the NHS Constitution 12 ;e) The Equality Act 2010 13 .

4.4. Accountability

4.4.1. We will demonstrate accountability to our members, local people, stakeholdersand the NCB in a number of ways, including by:a) Publishing our Constitution;b) Appointing independent lay members and non GP clinicians to our Governing

Body;c) Holding meetings of our Governing Body in public on a monthly basis (except

where we consider that it would not be in the public interest in relation to all orpart of a meeting) that will be communicated well in advance of the meetingdate not only through the CCG website and social media, but also via GPsurgeries and the local press;

d) Production of an extensive website, detailing our role, ways of working,policies, performance information, tender, contract, procurement and servicedetails as well as Board papers, consultations, decisions, local pathways,educational material and a Freedom of Information log and responses;

e) Disclosing on request all information that can lawfully be disclosed andflagging for inclusion on the websites Freedom of Information log;

9 Inserted by section 25 of the 2012 Act10 The Good Governance Standard for Public Services , The Independent Commission on Good Governance

in Public Services, Office of Public Management (OPM) and The Chartered Institute of Public Finance& Accountability (CIPFA), 2004

11

See Appendix F12 See Appendix G13 See http://www.legislation.gov.uk/ukpga/2010/15/contents


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f) Consulting our constituent practices, patients and the public, representativegroups and local organisations and getting their ideas and input via ourConsortia, representative groups, the monthly Clinical Commissioning Forum(CCF) and monthly newsletter;

g) Consulting on and publishing an annual commissioning plan developed with

our practices and partners;h) Complying with Local Authority health overview and scrutiny requirements;i) Working with the Health and Wellbeing Boards;

j) Meeting at least annually in public in an annual general meeting (AGM)topublish and present our annual report;

k) Producing annual accounts in respect of each financial year which must beexternally audited;

l) Having a published and clear complaints process;m) Complying with the Freedom of Information Act 2000;n) Through our patient and public engagement strategy available on our website;o) Providing information to the NCB as required;p) Calling a Members Forum meeting.

4.4.2. The Governing Body of the CCG will, throughout each year, have an ongoing rolein reviewing our governance arrangements to ensure that we continue to reflectthe principles of good governance and reflect on our experiences.

4.4.3. We recognise the role of the City and Hackney Local Medical Committee (LMC) inrepresenting the professional interests of our GPs. We therefore are committed tomaintaining a strong open and effective collaborative relationship with the LMC

4.4.4. We will do this by;a) Ensuring senior CCG representatives attend meetings of the City and

Hackney LMCb) Keeping the LMC fully briefed on potential issues related to the delivery of

services in practices as providers arising from the commissioning andactivities of the CCG

c) Sharing the Governing Body and Clinical Executive papers with the LMCprior to each meeting and invite a representative to attend.

d) Recognising that LMC representatives have the opportunity to raise issuesat consortia meetings and/or a Members Forum meeting, as well as through

the Chair or Chief Officere) Asking the LMC to oversee GP election processes


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5. OUR FUNCTIONS AND GENERAL DUTIES

5.1. Functions

5.1.1. The functions that we are responsible for exercising are largely set out in the 2006

Act, as amended by the 2012 Act. An outline of these appears in the Departmentof Health's Functions of CCGs 14 . They relate to:a) Commissioning certain health services (where the NCB is not under a duty to

do so) that meet the reasonable needs of:i) All people registered with member practices;ii) People who are usually resident within the area and are not registered

with a member of any CCG.b) Commissioning emergency care for anyone present in the CCGs area;c) Paying its employees' remuneration, fees and allowances in accordance with

the determinations made by its Governing Body and determining any otherterms and conditions of service of the CCGs employees;

d) Determining the remuneration and travelling or other allowances of membersof its Governing Body.

5.1.2. The CCG delegates to the Governing Body and its committees the performance ofits functions set out in Clause 5.1.1.

5.1.3. In discharging its functions, the CCG and the Governing Body on its behalf will:a) Act 15 , when exercising our functions to commission health services,

consistently with the discharge by the Secretary of State and the NHSCommissioning Board of their duty to promote a comprehensive healthservice 16 and with the objectives and requirements placed on the NHSCommissioning Board through the mandate 17 published by the Secretary ofState before the start of each financial year by:i) Delegating responsibility for exercising and ensuring compliance with this

function to the Governing Body and its sub committees as laid out in theStanding Orders and in line with the vision, values and aims as laid out insection 4 of the Constitution.

b) Meet the public sector equality duty 18 by delegating responsibility for thisfunction to the Governing Body to ensure the CCG operates with due regardto:i) Elimination of unlawful discrimination harassment and victimisation and

other conduct prohibited by the 2010 Act;ii) Advancing equality of opportunity between people who share a protectedcharacteristic and those who do not;

iii) Fostering good relations between people who share a protectedcharacteristic and those who do not.

c) Work in partnership with Local Authorities to develop joint strategic needsassessments 19 and joint health and wellbeing strategies 20 by:

14 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_134570 15 See section 3(1F) of the 2006 Act, inserted by section 13 of the 2012 Act16 See section 1 of the 2006 Act, as amended by section 1 of the 2012 Act17

See section 13A of the 2006 Act, inserted by section 23 of the 2012 Act18 See section 149 of the Equality Act 2010, as amended by paragraphs 184 and 186 of Schedule 5of the 2012 Act
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_134570http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_134570http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_134570http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_134570


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i) Membership of the City of London Corporation and London Borough ofHackney Health and Wellbeing Boards.

5.2. General Duties

5.2.1. We are responsible for making arrangements to:a) Secure public involvement in the planning, development and consideration of

proposals for changes and decisions affecting the operation of commissioningarrangements 21 . These duties are delegated to our Governing Body who willabide by the following principles:i) Working in partnership with patients, carers and the local community to

secure the best care for them;ii) Adapting engagement activities to meet the specific needs of different

patient groups and communities;iii) Publishing information about health services on the CCGs website and

through other media;iv) Encouraging and acting on feedback;v) Developing a Communications and Patient Public Involvement strategy

that expands on these principles, details how we will implement them andhow we will monitor and report compliance.

5.2.2. The CCG will fulfil the following general duties by delegating responsibility forexercising and ensuring compliance to the Governing Body and its subcommittees as laid out in the Standing Orders and in line with the vision, valuesand aims as laid out in section 4 of the Constitution:a) Promote awareness of, and act with a view to securing that health services

are provided in a way that promotes awareness of, and have regard to theNHS Constitution 22;

b) Act effectively, efficiently and economically 23;c) Act with a view to securing continuous improvement to the quality of

services 24;d) Assist and support the NCB in relation to the Governing Body's duty to

improve the quality of primary medical services 25;e) Have regard to the need to reduce inequalities 26;f) Promote the involvement of patients, their carers and representatives in

decisions about their healthcare 27;g) Act with a view to enabling patients to make choices 28;

19 See section 116 of the Local Government and Public Involvement in Health Act 2007, asamended by section 192 of the 2012 Act20 See section 116A of the Local Government and Public Involvement in Health Act 2007, asinserted by section 191 of the 2012 Act21 See section 14Z2 of the 2006 Act, inserted by section 26 of the 2012 Act22 See section 14P of the 2006 Act, inserted by section 26 of the 2012 Act and section 2 of theHealth Act 2009 (as amended by 2012 Act)23 See section 14Q of the 2006 Act, inserted by section 26 of the 2012 Act24 See section 14R of the 2006 Act, inserted by section 26 of the 2012 Act25 See section 14S of the 2006 Act, inserted by section 26 of the 2012 Act26

See section 14T of the 2006 Act, inserted by section 26 of the 2012 Act27 See section 14U of the 2006 Act, inserted by section 26 of the 2012 Act28 See section 14V of the 2006 Act, inserted by section 26 of the 2012 Act


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h) Obtain appropriate advice from persons who, taken together, have a broadrange of professional expertise in healthcare and public health 29 ;

i) Promote innovation 30; j) Promote research and the use of research 31;k) Have regard to the need to promote education and training 32 for persons who

are employed, or who are considering becoming employed, in an activitywhich involves or is connected with the provision of services as part of thehealth service in England so as to assist the Secretary of State for Health inthe discharge of his related duty 33;

l) Act with a view to promoting integration of both health services with otherhealth services and health services with health-related and social careservices where the CCG considers that this would improve the quality ofservices or reduce inequalities 34 .

5.3. General Financial Duties

5.3.1. The CCG will fulfil the following financial duties by delegating responsibility forexercising and ensuring compliance to the Governing Body and its subcommittees as laid out in the Standing Orders and in line with the vision, valuesand aims as laid out in section 4 of the Constitution:a) Ensure its expenditure does not exceed the aggregate of its allocations for the

financial year 35;b) Ensure its use of resources (both its capital resource use and revenue

resource use) does not exceed the amount specified by the NCB for thefinancial year 36;

c) Take account of any directions issued by the NCB, in respect of specifiedtypes of resource use in a financial year, to ensure the CCG does not exceedan amount specified by the NCB 37;

d) Publish an explanation of how the CCG spent any payment in respect ofquality made to it by the NCB 38 .

5.4. Other Relevant Regulations, Directions and Documents

5.4.1. The CCG will:a) Comply with all relevant regulations;b) Comply with directions issued by the Secretary of State for Health or the NCB;c) Take account, as appropriate, of documents issued by the NCB

d) Develop, consult on and implement the necessary systems and processes tocomply with these regulations and directions, documenting them as necessary

29 See section 14W of the 2006 Act, inserted by section 26 of the 2012 Act30 See section 14X of the 2006 Act, inserted by section 26 of the 2012 Act31 See section 14Y of the 2006 Act, inserted by section 26 of the 2012 Act32 See section 14Z of the 2006 Act, inserted by section 26 of the 2012 Act33 See section 1F(1) of the 2006 Act, inserted by section 7 of the 2012 Act34 See section 14Z1 of the 2006 Act, inserted by section 26 of the 2012 Act35 See section 223H(1) of the 2006 Act, inserted by section 27 of the 2012 Act36

See sections 223I(2) and 223I(3) of the 2006 Act, inserted by section 27 of the 2012 Act37 See section 223J of the 2006 Act, inserted by section 27 of the 2012 Act38 See section 223K(7) of the 2006 Act, inserted by section 27 of the 2012 Act


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in this Constitution, its scheme of reservation and delegation and otherrelevant CCG policies and procedures.


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6. DECISION MAKING: OUR GOVERNING STRUCTURE

6.1. Authority to act

6.1.1. The CCG is accountable for exercising the statutory functions of the CCG. It may

grant authority to act on its behalf to:a) Any of its members;b) Its Governing Body and its committees;c) Employees;d) A committee or sub-committee of the CCG.

6.1.2. The extent of the authority to act of the respective bodies and individuals dependson the powers delegated to them by the CCG as expressed through:a) The CCGs scheme of reservation and delegation;b) For committees, their terms of reference.

6.2. Scheme of Reservation and Delegation 39

6.2.1. Our scheme of reservation and delegation is detailed in appendix D and sets out;a) Those decisions that are reserved for the membership as a whole;b) Those decisions that are the responsibilities of our Governing Body (and its

committees), the CCGs committees and sub-committees, individual membersand employees.

6.2.2. The CCG remains accountable for all of its functions, including those that it hasdelegated.

6.3. General

6.3.1. In discharging the functions of the CCG that have been delegated to its GoverningBody (and its committees), all individual committee members are expected to:a) Comply with the CCGs principles of good governance 40;b) Operate in accordance with our scheme of reservation and delegation 41;c) Comply with our standing orders 42;d) Comply with our arrangements for discharging our statutory duties 43;e) Where appropriate, ensure that member practices have had the opportunity to

contribute to our decision making process.

6.3.2. When discharging their delegated functions, committees and individuals must alsooperate in accordance with the approved terms of reference.

6.3.3. Where delegated responsibilities are being discharged collaboratively, the joint(collaborative) arrangements must:a) Identify the roles and responsibilities of those CCGs who are working

together;

39 See Appendix D40 See section 4.3 on Principles of Good Governance above41

See appendix D42 See appendix C43 See chapter 5 above


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b) Identify any pooled budgets and how these will be managed and reported inannual accounts;

c) Specify under which CCGs scheme of reservation and delegation andsupporting policies the collaborative working arrangements will operate;

d) Specify how the risks associated with the collaborative working arrangement

will be managed between the respective parties;e) Identify how disputes will be resolved and the steps required to terminate the

working arrangements;f) Specify how decisions are communicated to the collaborative partners.

6.4. Consortia

6.4.1. The CCG has six members Consortia as listed in appendix B of this Constitution.

6.4.2. Application to join or change Consortium is made in writing by the lead practiceGP to the Lead of the Consortium they wish to join.

6.4.3. The Consortium members consider the application collectively and agree theirdecision which is communicated to the applying practice and to the CCG within 4weeks of the receipt of the application.

6.4.4. New Consortium membership is ratified by the Members Forum.

6.5. Consortia Leads

6.5.1. Each Consortium has a Lead that must be a GP and as such:a) Be either an active partner, a sessional GP or locum of a Member;b) Shall not be eligible if they are, or subsequently are retired from the Member,

suspended by either the General Medical Council (GMC) or the NHSCommissioning Board or any successor body;

c) If the individual is a sessional GP, he shall not be eligible in the event that heis suspended from his employment or subject to grievance or disciplinaryproceedings;

d) For those individuals (including those stated at (c) above) who are not party todirect contractual arrangements for the provision of primary medical services,they must be on the National Commissioning Boards Performers List.

e) The Chair and Vice Chair of the Local Medical Committee (LMC) cannot be a

Consortium representative and consequently cannot be a Governing Bodymember or Clinical Executive Committee member.

6.5.2. The constituent Members of each Consortium decide how to appoint theirConsortia Lead and Deputy.

6.5.3. The Consortium Members choose, by a simple majority, to:a) Have a Lead and a Deputy or a job share Lead;b) Elect or appoint their Lead(s);c) Election and/or selection process for the Leads;d) Constituency - i.e. who can stand - for each position.


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6.5.4. Consortia should inform the LMC and governing body of their election/selectionprocess.

6.5.5. A Consortium Lead is required to notify the Governing Body of their electionproviding evidence that the process detailed in 6.5.3 and the criteria in 6.5.1 of this

Constitution has been followed.

6.5.6. Each Consortium Lead has a term of office of 2 years.

6.5.7. Three months notice should be given on resigning from the role of ConsortiumLead.

6.5.8. If at least 51% of a Consortiums members express that they no longer haveconfidence in their Consortium Lead, they can commence a newselection/election process at any time during their term of office.

6.5.9. The Consortia Leads feed in the views of their constituent Members to inform theCCGs decision making, policies and processes.

6.5.10. Any Consortium representative can request, in writing to the CCG Chair that anitem is discussed and addressed at the next meeting of the Governing Body.

6.6. Committees of the Group

6.6.1. The Group shall have a committee called the Members Forum which shallcomprise all of the Practice Representatives at any one time. If a resolution ispassed by the Members Forum by a majority of at least 51% of all the PracticeRepresentatives, the Governing Body is required to abide by the decision of theForum.

6.6.2. The Group may, on or after its establishment, appoint such other committees as itconsiders appropriate.

6.7. Joint arrangements

6.7.1. The CCG may enter into joint arrangements with other CCGs including the jointarrangements detailed in Appendix H.

6.7.2. The group may establish joint committees with one or more local authorities as itconsiders may be appropriate.

6.8. The CCG Governing Body

6.8.1. The Governing Body shall not have less than 9 members and comprises of:a) Three GP members, one of whom will be the Chair of the Governing Body;b) Two lay members:

i) One to lead on audit, remuneration and conflict of interest matters;ii) One to lead on patient and public participation matters.

c) One registered nurse;d) One secondary care specialist doctor;


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e) The Accountable Officer;f) The Chief Finance Officer;g) Other attendees as invited, including LINks / Health Watch representatives

from the City of London and London Borough of Hackney and CommissioningSupport Service (CSS) and the Local Medical Council representative, to

provide advice and support, not as formal members of the Governing Body.

6.8.2. Three months notice should be given on resigning from any Board post.

6.8.3. Any member of the Governing Body, including the Chair may be removed by amajority vote of no-confidence by the Governing Body requiring at least one thirdof votes available.

6.8.4. Selecting the GPs for the Governing Body:a) Each of the Consortia Leads is eligible to be one of the three GP members of

the Governing Body;b) A Consortium Lead who applies to be a GP member of the Governing Body

shall be assessed in accordance with an assessment process to berecommended by the Remuneration Committee and approved by the +;

c) The Governing Body will decide if the Consortium Lead has satisfactorilycompleted the assessment such that he or she is a suitable person to be oneof the three GP members of the Governing Body;

d) The Consortia Leads shall decide by a simple majority the process by whichthey are selected to be GP members of the Governing Body but a ConsortiumLead may go forward for selection only if the Governing Body has decided thathe or she is a suitable person to be one of the three GP members of theGoverning Body;

e) If a ballot is required, then the Consortia Leads can decide who should vote(i.e. just the Consortia Leads or the wider GP membership);

f) Any election process involving the wider GP membership will need to beratified by a majority vote of the Members Forum.

g) A Consortium Leads appointment or election as a GP member of theGoverning Body will be subject to ratification by a majority vote of theMembers Forum.

6.8.5. Selecting the Chair of the Governing Body:a) One of the 3 GP members of the Governing Body will be the Chair of the

Governing Body;b) The Chair of the Governing Body will be appointed by majority vote of themembers of the Governing Body;

c) The appointment of the Chair of the Governing Body will be subject toratification by a majority vote of the Members Forum;

d) Once the Chair has been agreed, that GP relinquishes their post as lead forthe Consortium and the relevant Consortium chooses another GPrepresentative for the CEC;

e) One of the other 2 GP members of the Governing Body is appointed bymajority vote of the Governing Body as Clinical Vice Chair.

f) The Deputy Chair shall be one of the members of the Governing Body who is

a lay person and shall be appointed by majority vote of the Governing Body.g) All GP positions on the Governing Body and CEC are for a 2 year period;


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h) After 2 years the positions are subject to election. No Chair/Vice Chair shallserve for a period of more than 3 terms without a break of at least 2 years.

6.9. Lay Members

6.9.1. The lay members as listed in 6.8.1.b) of this Constitution are subject to thefollowing appointment process:a) They will be recruited following national advert, shortlisting and interview as

recommended by the Remuneration Committee and approved by theMembers Forum.

b) Following ratification by a majority vote of the Members Forum, they will beappointed for a two year period.

c) Subject to satisfactory performance, the Remuneration Committee mayrecommend them for a second term without having to reapply via opencompetition but the Remuneration Committee must consult the MembersForum and take account of any views expressed collectively or individually bythe Members.

d) They cannot undertake more than 2 consecutive terms of office.e) They may be removed by a vote of no-confidence by the Governing Body

requiring at least one third of votes available.

6.10. Nurse Member

6.10.1. The independent nurse member of the Governing Body must have at least 5 yearsof post qualification experience and will be recruited following national advert,shortlisting and interview as recommended by the Remuneration Committee andapproved by the Members Forum.

6.10.2. Subject to ratification by a majority vote of the Members Forum, they will beappointed for a two year period.

6.10.3. Subject to the exceptions stated in Clause 6.10.4 the independent nurse membercannot:

a) Be an employee or member (including shareholder) of or a partner in aprovider of primary care medical services, or a provider with whom the CCGhas made commissioning arrangements.

b) Cannot work for more than 50% of their time for a non NHS organisation.

6.10.4. The exceptions are where the CCG has made an arrangement with a provider,subsequent to a patient exercising choice, and where the CCG has made anarrangement with a provider in special circumstances to meet the specific needsof a patient (for example, where there is a very limited choice of provider for ahighly specialised service). This is especially in relation to this particular role anddoes not preclude practice nurses from being members of the Governing Body inother capacities.

6.10.5. The independent nurse member may be removed by, in addition to that covered in6.8.3:

a) If they are not registered with the Nursing and Midwifery Council under theNursing and Midwifery Order 2001;


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b) Are no-longer practising for another reason.

6.10.6. Subject to satisfactory performance, the Remuneration Committee mayrecommend to the Members Forum the appointment of the independent nursemember for a second term without having to reapply via open competition. The

Remuneration Committee must consult the Members Forum and take account ofany views expressed collectively or individually by the Members.

6.11. Hospital Consultant

6.11.1. The hospital consultant member of the Governing Body must have at least 5 yearsexperience as a consultant and will be recruited following national advert, shortlisting and interview as recommended by the Remuneration Committee andapproved by the members Forum

6.11.2. Subject to ratification by a majority vote of the Members Forum, they will beappointed for a two year period.

6.11.3. Whilst the individual may well no longer practise medicine, they will need todemonstrate that they still have a relevant understanding of care in the secondarysetting.

6.11.4. The secondary care specialist:a) Cannot be an employee or member (including shareholder) of, or a partner

in a provider of primary medical services, or a provider with whom the CCGhas made commissioning arrangements.

b) Cannot work for more than 50% of their time for a non NHS organisation

6.11.5. The exceptions are where the CCG has made an arrangement with a provider,subsequent to a patient exercising choice, and where the CCG has made anarrangement with a provider in special circumstances to meet the specific needsof a patient (for example, where there is a very limited choice of provider for ahighly specialised service).

6.11.6. The hospital consultant member may be removed by, in addition to that covered in6.8.3:a) If they lose their license to practice;

b) Are no-longer practicing for another reason.6.11.7. They will be appointed for a term of two years.

6.11.8. Subject to satisfactory performance, the Remuneration Committee mayrecommend to the Members Forum the appointment of the hospital consultantmember for a second term without having to reapply via open competition. TheRemuneration Committee must consult the Members Forum and take account ofany views expressed collectively or individually by the Members.

6.12. Board Disqualification Guidance


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membership of the Finance and Performance Committee. The FPC has thefollowing role:i) To receive the monthly finance, activity and KPI reports produced by the

CSS;ii) To receive a monthly report on progress with implementation of the

Quality, Innovation, Productivity and Prevention (QIPP) plans;iii) To agree responsibilities and implement action plans and reporting

arrangements for variances or areas of performance identified;iv) The CCGs CFO will ensure that remedial actions plans are reported to the

Governing Body as part of the performance reporting arrangements andthat progress is monitored.

c) Patient and Public Involvement (PPI) Committee which is accountable tothe CCGs Governing Body. The Governing Body has approved and keepsunder review the terms of reference for the PPI which includes informationon the membership of the PPI Sub Committee. The PPI Committee has thefollowing role:i) to develop and deliver the CCGs engagement plans which are

consistent with para 5.2.1ii) to oversee and coordinate the various sources of patient carer and

public views and issues on the services which the ccg commissions andensure that the ccg has a comprehensive understanding of these

iii) to make recommendations to the Governing Body and via ourprogramme boards and clinical executive on changes to ourcommissioning plans to address these issues satisfactorily

iv) to ensure that learning from complaints takes place and is reflected inour commissioning plans and to ensure that the complaintsmanagement service received from the CSS is robust and meeting thespecification

v) to ensure that we communicate back to our patients and public on whatwe have done about the issues they have raised

6.13.3. The Audit Committee may include individuals who are not members of theGoverning Body.

6.13.4. Other committees of the Governing Body may include individuals who are notmembers of the Governing Body but are:

a) Members, officers or governing body members of the Group or anotherclinical commissioning group

b) Partners or employees of Members of the Group or another clinicalcommissioning group.

6.13.5. Committees of the Governing Body will only be able to establish their own sub-committees, to assist them in discharging their respective responsibilities, if thisresponsibility has been delegated to them by the Governing Body or thecommittee they are accountable to.


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6.13.6. All decisions taken in good faith at a meeting of the Governing Body or anycommittee or sub-committee of it shall be valid even if there is any vacancy in itsmembership or it is discovered subsequently that there was a defect in the callingof the meeting, or the appointment of a member attending the meeting.

6.14. Membership of the Clinical Executive Committee

6.14.1. In addition to the 6 Consortia leads, the other members of the Clinical ExecutiveCommittee (CEC) are:a) A representative of the Members Practice Managers (the Practice Managers

representative);b) A representative of the Members Practice Nurses (the Practice Nurses

representative);c) The CCGs lay member with an interest in PPI;d) The Accountable Officer (AO);e) The Chief Financial Officer(CFO)f) The Chair of the Governing Body.

6.14.2. A representative of Commissioning Support Service (CSS) may be invited toattend to provide advice and support, but not as a formal member of theCommittee.

6.14.3. In addition, the CCG Clinical Chairs of the Programme Boards and Local MedicalCommittee (LMC) Chair will receive papers for the Committee and be invited toattend to provide advice and support, but not as formal members of theCommittee.

6.14.4. The CCG lay member for PPI, Accountable Officer and CFO are members of theClinical executive in an ex-officio capacity.

6.14.5. The practice managers and nurses from Members listed in Appendix B can decidehow to appoint their respective representatives onto the CEC. They can choose,by a simple majority:a) To elect or appoint their lead(s);b) The election and/or selection process for the leads;c) Eligibility criteria for each position.

6.14.6. Subject to ratification by a majority vote of the Members Forum, the GoverningBody will appoint them for a two year period.

6.14.7. If at least 51% of practice managers or nurses express that they no longer haveconfidence in their respective representative in a meeting, they can commence anew selection/election process at any time during their term of office.

6.14.8. The GP elected as clinical vice chair of the board becomes the Chair of theclinical executive. The deputy/job share for that GP then joins the clinicalexecutive to represent that consortium.

6.15. Disputes


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We are committed to engaging with our Members around all strategic proposals anddevelopments using the Clinical Commissioning Forum and Consortia forconsultation and feedback. However where a member finds they have a dispute orgrievance with the CCG, or its Governing Body or committees to whom it hasdelegated powers about;

a) Matters of eligibility for membershipb) The interpretation and application of their respective powers and obligations

under this constitution orc) A decision which the CCG has made on behalf of its members ord) Any other relevant matter that the ccg considers fair and equitable to be the

subject of a grievance or of a complaintit will follow the dispute resolution process set out as follows.

6.15.1. All CCG policies and decisions which involve payments to members by the CCGwill have a documented formal approach process.

6.15.2. It is anticipated that most disputes will be resolved at the consortium level by amember raising the issue with the consortium lead in writing within 60 days of theissue arising.

6.15.3. The consortium lead will respond to the member in writing within 30 days. If thelead is absent they can ask their deputy or the CCG Chair to resolve the issue. Inthis case the CCG Chair can direct any other consortium lead to receive andresolve the issue.

6.15.4. If the consortium lead is unable to resolve the issue the member may write to theCCG Chair (or if the Chair is unavailable, to the Vice Chair/lay member) clearlyoutlining the issue. The Chair in conjunction with the Chief Officer whereappropriate will contact the member within 30 days and resolve the dispute.

6.15.5. Where the dispute is unable to be resolve in 6.15.4, the parties may decide at theirown cost to refer to mediation. The independent third party member, beingapproved by the centre for effective dispute resolution.

6.15.6. A member practice can also request that the LMC raise the matter on their behalfand step 16.15.2 to 16.15.5 will apply.

6.15.7. Members also have the ability to call a members forum via their consortium lead.


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7. Roles and Responsibilities

7.1. Practice Representative

7.1.1. Practice Representatives represent their Members views and act on behalf of the

Member in matters relating to the Group.

7.1.2. The role of each practice representative is to:a) Ensure effective two way communications between the CCG and the Member;b) Engage in Consortia and the Clinical Commissioning Forum (CCF) and other

activities;c) Ensure democracy and input to CCG decisions;d) To be a member of the Members Forum as detailed in section 7.5

7.2. Clinical Commissioning Forum

7.2.1. The CCG will use the monthly Clinical Commissioning Forum, which is open to allGPs working for a City and Hackney practice, as well as Consortia meetings, toconsult and engage all member practices to debate our clinical plans, for earlyinvolvement from practices in shaping our plans, service models and strategiesand for testing out ideas.

7.3. Consortia

7.3.1. Each Consortium plays a key role in providing a peer support network forconstituent practices, for communication and input to CCG plans thinking anddecisions.

7.4. Consortium Lead

7.4.1. The role of the elected Consortium lead is to undertake the following on behalf ofthe CCG:a) Support the work of the Consortia;b) Represent the Consortium rather than represent their own individual practices;c) Chair the Consortium meetings;d) Ensure effective two way communications with constituent practices,

representing their views at CCG meetings;

e) Provide input to the CCGs clinical plans and represent the Consortium viamembership of the Clinical Executive Committee (CEC).

7.5. Members Forum

7.5.1. The role of the Members Forum is to:a) consider and agree any changes to the Constitution as laid out in 1.4 including

changes in membership of the CCG;b) confirm the appointments process for Governing Body members;c) ratify all appointments to the Governing Body;d) consider any issue of no confidence in Governing Body members either

individually or collectively;


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e) debate any concerns regarding discussions and decisions by the GoverningBody

7.6. All Members of the CCGs Governing Body

7.6.1. Each member of the Governing Body should share responsibility as part of a teamto ensure that the CCG exercises its functions effectively, efficiently andeconomically, with good governance and in accordance with the terms of thisConstitution. Each brings their unique perspective, informed by their expertiseand experience.

7.7. The Chair

7.7.1. The Chair of the Governing Body in conjunction with the Governing Body isresponsible for:a) Leading the Governing Body, ensuring it remains continuously able to

discharge its duties and responsibilities as set out in this Constitution;b) Providing clinical leadership;c) Taking account of the views of member practices when making decisions;d) Building and developing the Governing Body and its individual members;e) Ensuring that the CCG has proper constitutional and governance

arrangements in place;f) Ensuring that, through the appropriate support, information and evidence, the

Governing Body is able to discharge its duties;g) Supporting the Accountable Officer in discharging the responsibilities of the

organisation;h) Contributing to building a shared vision of the aims, values and culture of the

organisation;i) Leading and influencing to achieve clinical and organisational change to

enable the CCG to deliver its commissioning responsibilities; j) Overseeing governance and particularly ensuring that the Governing Body

and the wider CCG behaves with the utmost transparency andresponsiveness at all times;

k) Ensuring that public and patients' views are heard and their expectationsunderstood and, where appropriate as far as possible, met;

l) Ensuring that the organisation is able to account to its local patients,stakeholders and the NCB;

m) Ensuring that the CCG builds and maintains effective relationships,particularly with the individuals involved in overview and scrutiny from therelevant Local Authorities.

7.7.2. Where the Chair of the Governing Body is also the senior clinical voice of the CCGthey will take the lead in interactions with stakeholders, including the NCB.

7.8. The Deputy Chair

7.8.1. The Deputy Chair of the Governing Body deputises for the Chair of the GoverningBody where he or she has a conflict of interest or is otherwise unable to act.

7.8.2. The deputy chair is the lay member for audit remuneration and matters of conflictof interest as per para 6.8.1c.i


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7.9. The Accountable Officer

7.9.1. The Accountable Officer is subject to an appointment process by interview andother requirement as may be set out in guidelines or regulation or the CCGs HR

policy and varied from time to time.

7.9.2. The Accountable Officer may be removed in line with their contract ofemployment.

7.9.3. The Accountable Officer:a) Is responsible for ensuring that the CCG fulfils its duties to exercise its

functions effectively, efficiently and economically thus ensuring improvementin the quality of services and the health of the local population whilstmaintaining value for money;

b) Will at all times ensure that the regularity and propriety of expenditure isdischarged, and that arrangements are put in place to ensure that goodpractice (as identified through such agencies as the Audit Commission andthe National Audit Office) is embodied and that safeguarding of funds isensured through effective financial and management systems;

c) Working closely with the Chair of the Governing Body, will ensure that properconstitutional, governance and development arrangements are put in place toassure the members (through the Governing Body) of the organisation'songoing capability and capacity to meet its duties and responsibilities. Thiswill include arrangements for the development of its members and staff.

7.10. Chief Financial Officer

7.10.1. The Chief Financial Officer is subject to an appointment process of interview andother requirement as may be set out in guidelines or regulation or the CCGs HRpolicy and varied from time to time.

7.10.2. The Chief Financial Officer may be removed in line with their contract ofemployment.

7.10.3. The Chief Financial Officer is a member of the Governing Body and is responsiblefor providing financial advice to the CCG and for supervising financial control and

accounting systems.7.10.4. This role of Chief Financial Officer is responsible for:

a) Being the Governing Body's professional expert on finance and ensuring,through robust systems and processes, the regularity and propriety ofexpenditure is fully discharged;

b) Making appropriate arrangements to support, monitor on the CCGs finances;c) Overseeing robust audit and governance arrangements leading to propriety in

the use of the CCGs resources;d) Being able to advise the Governing Body on the effective, efficient and

economic use of the CCGs allocation to remain within that allocation and

deliver required financial targets and duties;


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e) Producing the financial statements for audit and publication in accordancewith the statutory requirements to demonstrate effective stewardship of publicmoney and accountability to the NCB.

7.11. The Role of the Governing Body

7.11.1. The functions of the Governing Body shall include:a) Ensuring that the CCG has appropriate arrangements in place to exercise its

functions effectively, efficiently and economically and in accordance with theCCGs principles of good governance 47 (its main function);

b) Ensuring effective engagement of member practices, patients and the publicin consultation and decision making;

c) Ensure that all providers of primary medical services in the locality aremembers of the CCG, and shall keep up to date registers of the same;

d) Determining the remuneration, fees and other allowances payable toemployees or other persons providing services to the CCG and theallowances payable under any pension scheme it may establish underparagraph 11(4) of Schedule 1A of the 2006 Act, inserted by Schedule 2 ofthe 2012 Act;

e) Approving any functions of the CCG that are specified in regulations 48;f) Monitoring the clinical quality and safety of all commissioned services through

regular reports produced by CSS;g) Assuring decision making arrangements;h) Oversight of the arrangements for dealing with conflict of interest;i) Leading the setting of our vision and strategy and ensuring these are followed

j) Approving commissioning plans and strategy on behalf of the CCG;k) Facilitate the delivery and implementation of any guidance or standards

issued by any relevant regulatory body including but not limited to the CareQuality Commission (CQC) or any successor bodies or their authorisedassignees;

l) Ensure that there are robust plans and responsibilities assigned to managestaff engagement, external relationships and communications;

m) Approving annual budget;n) Monitoring performance against the plan and budget;o) Support a variety of and diverse approaches to commissioning, particularly for

practices to work proactively to improve efficiency and value;p) Encourage innovation by enabling and supporting practices and clinicians in

creating changes;q) Work with all local stakeholders to achieve delivery of the targets, policies andstandards;

r) Work collaboratively to deliver the outcomes and milestones set out in anyLocal Delivery Plan;

s) Will exercise and/or delegate functions which have not otherwise beenexpressly delegated under the Constitution

t) Comply with all relevant procurement law and policy and adhere to theobligations placed on the governing Board and CCG with regard to allproviders applying the following principles of:

47 See section 4.3 on Principles of Good Governance above48 See section 14L(5) of the 2006 Act, inserted by section 25 of the 2012 Act


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i) Transparency and openness;ii) Support, assistance and training so as to permit compliance with

procurement law, competition law and any relevant policies;iii) Application of guidance within the 'procurement guide for commissioners

of NHS funded services' and the 'principles and rules for co-operation and

competition';iv) Equality of treatment.

u) Providing assurance of strategic risks.

7.11.2. The Governing Body shall:

a) Ensure that all decisions made in relation to commissioning are fully recordedand auditable.

b) Be engaged in the day to day management and application of commissioningand related activity in the locality and shall operate in good faith using all dueskill and diligence.

c) Provide reports of all activity including financial activity at all meetings. Thereports shall be available to all governing body members prior to thegoverning body meetings and form part of the main agenda.

d) Ensure that all the CCGs policies and procedures with regard to theinvolvement and consultation of patients and practices and other relevantbodies are fully complied with at all times.

e) Fairly and equitably advertise any specific salaried posts.

f) Adhere to any other obligations as set out in statute, regulation and/ordirection.

g) Implement all processes required to comply with any regulation, direction orinternal governance where relevant.

h) Keep an up-to-date list of all committees, sub-committees and joint workingarrangements.

i) Agree a set of standing orders (set out in appendix C) which shall dictateprocesses by which the CCG shall operate, including but not limited to anyelection process, quorum and frequency of elections.

7.12. Joint Appointments with other Organisations

7.12.1. The Group may agree joint appointments with other Clinical CommissioningGroups as it considers may be appropriate including:a) Chief Finance Officer (with NHS Tower Hamlets CCG);b) Rest of finance team (with NHS Tower Hamlets CCG).

7.12.2. All joint appointments shall be supported by a memorandum of understandingbetween the organisations who are party to them, outlining:


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a) Who will be the statutory employer of the individual(s) working acrossorganisations;

b) Confirmation that the statutory employer's policies will apply in all mattersconcerning the employment of the individual;

c) The arrangements for funding, including funding for any temporary or acting

arrangements in the event of absence, funding of redundancy costs andfunding for training and development etc;

d) The arrangements for approval of annual and special leave of the individual;e) Performance appraisal;f) How disciplinary matters will be handled;g) Risk sharing arrangements in respect of liability issues or redundancy /

dismissal costs.


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8. Standards of Business Conduct and Managing Conflicts of Interest

8.1. Standards of Business Conduct

8.1.1. Employees, members, committee and sub-committee members of the CCG and

members of the Governing Body (and its committees) will at all times comply withthis Constitution and be aware of their responsibilities as outlined in it. Theyshould act in good faith and in the interests of the CCG and should follow theseven principles of public life, set out by the Committee on Standards in PublicLife (the Nolan Principles). The Nolan Principles are incorporated into thisConstitution at Appendix F.

8.1.2. They must comply with the CCGs policy on business conduct, including therequirements set out in the policy for managing conflicts of interest. This policywill be available on the CCGs website.

8.1.3. Individuals contracted to work on behalf of the CCG or otherwise providingservices or facilities to the CCG will be made aware of their obligation with regardto declaring conflicts or potential conflicts of interest. This requirement will bewritten into their contract for services.

8.2. Conflicts of Interest

8.2.1. As required by section 14O of the 2006 Act and as inserted by section 25 of the2012 Act, we will make arrangements to manage conflicts and potential conflictsof interest to ensure that decisions made by the CCG will be taken and seen tobe taken without any possibility of the influence of external or private interest.We will abide by the safeguards set out in the NHS Commissioning Boardsguidance Code of Conduct: managing conflicts of interest (July 2012) and theCCGs Conflicts of Interest policy that it may adopt from time to time.

8.2.2. Where an individual who is a CCG employee, CCG member, member of theGoverning Body, or a member of a committee or a sub-committee of the CCG orits Governing Body has an interest, or becomes aware of an interest which couldlead to a conflict of interests in the event of the CCG considering an action ordecision in relation to that interest, that must be considered as a potentialconflict, and is subject to the provisions of this Constitution and the CCGs

Conflicts of Interest policy.8.2.3. The aim is to protect both the CCG and the individuals involved from any

appearance of impropriety and demonstrate our culture of openness andtransparency to the public and other interested parties.

8.2.4. The Governing Bodys members have ultimate responsibility for all actionscarried out by staff and committees throughout the CCGs activities. Thisresponsibility includes the stewardship of significant public resources and thecommissioning of healthcare to the community. We will therefore ensure theorganisation inspires confidence and trust amongst its partners and members by

demonstrating integrity and avoiding any potential or real situations of unduebias or influence in the decision-making of the CCG.


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8.2.5. Where the Chair of any meeting of the CCG, including committees, sub-committees, or the Governing Body and the Governing Body's committees andsub-committees, has a personal interest, previously declared or otherwise, inrelation to the scheduled or likely business of the meeting, they must make a

declaration and the deputy Chair will act as Chair for the relevant part of themeeting. Where arrangements have been confirmed for the management of theconflict of interests or potential conflicts of interests in relation to the Chair, themeeting must ensure these are followed. Where no arrangements have beenconfirmed, the deputy Chair may require the Chair to withdraw from the meetingor part of it. Where there is no deputy Chair, the members of the meeting willselect one.

8.2.6. Where more than 50% of the members of a meeting are required to withdrawfrom a meeting or part of it, owing to the arrangements agreed for themanagement of conflicts of interests or potential conflicts of interests, the Chair(or deputy) will determine whether or not the discussion can proceed.

8.2.7. In making this decision, the Chair will consider whether the meeting is quorate, inaccordance with the number and balance of membership set out in the CCGsstanding orders. Where the meeting is not quorate, owing to the absence ofcertain members, the discussion will be deferred until such time as a quorum canbe convened. Where a quorum cannot be convened from the membership of themeeting, owing to the arrangements for managing conflicts of interest or potentialconflicts of interests, the Chair of the meeting shall consult with AccountableOfficer on the action to be taken.

8.2.8. This may include:a) Requiring another of the CCGs committees or sub-committees, the CCGs

Governing Body or the Governing Body's committees or sub-committees (asappropriate) which can be quorate to progress the item of business, or if thisis not possible;

b) Inviting on a temporary basis one or more of the following to make up thequorum (where these are permitted members of the Governing Body orcommittee / sub-committee in question) so that the CCG can progress theitem of business:i) A member of the CCG who is an individual;

ii) An individual appointed by a member to act on its behalf in the dealingsbetween it and the CCG;iii) A member of a relevant Health and Wellbeing Board;iv) A member of a Governing Body of another CCG.

c) These arrangements must be recorded in the minutes.

8.2.9. Where the Governing Body is discussing and deciding on commissioning servicesfrom GP providers, the GP Governing Body members must excuse themselvesfrom the Governing Body and decisions made by a quorum of 1 lay member, 1clinician and 1 manager representative. These specific decisions cannot bechallenged by the Members Forum.


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8.2.10. When the CCG commissions services from GP practices, provider consortia ororganisations in which Members have a financial interest, then the CCGstemplate for commissioning such services must be completed in order to satisfythe requirement to give assurance to the Audit Committee and the Health andWellbeing Board.

8.2.11. Board members should not use confidential information acquired in the pursuit oftheir role to benefit themselves or another connected person.

8.2.12. We have a legal obligation to act in the best interests of the CCG and inaccordance with this Constitution and terms of establishment created by theNCB and to avoid situations where there may be a potential conflict of interest.

8.2.13. We will ensure that all employees and decision-makers are aware of the existenceof the Conflicts of Interest policy and Register of Interests which are bothpublished on our website. The following will be undertaken to ensure awareness:a) Introduction to the policy during local induction for new starters to the

organisation;b) Annual reminder of the existence and importance of the policy via internal

communication methods;c) Annual reminder to update declaration forms sent to all Board membersd) At each meeting of the Governing Body or a committee or subcommittee of

the Governing Body, the individuals present must declare any material interestwhich must be recorded in the minutes and (if not already registered) theregister of interests in accordance with Clause 8.3.

8.2.14. Further details of our responsibilities and details of how conflicts of interest areidentified, declared, recorded, communicated and acted on are contained in theconflicts of interest policy document.

8.3. Interests and gifts

8.3.1. Interests and gifts will be recorded on the register of interests and register of giftsand hospitality, which will be maintained by the Accountable Officer. The registerwill be accessible by the public and inspection of the register of Board membersinterests will be encouraged, as appropriate.

8.4. Managing Conflicts of Interest: contractors and people who provide servicesto the CCG

8.4.1. Anyone seeking information in relation to a procurement, or participating in aprocurement, or otherwise engaging with the CCG in relation to the potentialprovision of services or facilities to the CCG, will be required to make adeclaration of any relevant conflict / potential conflict of interest compliant withthe CCGs policy.

8.4.2. Anyone contracted to provide services or facilities directly to the CCG will besubject to the same provisions of this Constitution in relation to managing conflicts

of interests. This requirement will be set out in the contract for their services.


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ii) Maintain acceptable standards of health and safety and comply fullywith all legal obligations;

iii) Meet all tax and national insurance obligations;iv) Meet all equal opportunities legislation;v) Reputable in their standards of business conduct;

vi) Respect the environment and take appropriate steps to ensure that theyminimise their environmental impact;

vii) Can evidence a track record of providing high quality services andmeeting the above points on a consistent basis.

f) We will, in each procurement and consistently with the relevant law, excludecompanies which have been convicted of offences, or whose director(s) orany other person or company who has powers of representation, decision orcontrol of the company has or have been convicted of offences in theconduct of their business or committed an act of grave professionalmisconduct in the conduct of their business, such as breaches ofemployment, equal opportunities or environmental legislation. However, anycorrective/remedial action taken by the company in response to such anoffence should also be taken into account in determining its suitability as abidder;

g) We will, in each procurement and consistently with relevant EU andinternational law, ensure that contractual provisions, procurementprocedures and selection and award criteria prohibit or restrict contractorsuse of offshore jurisdictions and/or improper tax avoidance schemes orarrangements and/or exclude companies which use such jurisdictions and/orsuch schemes or arrangements;

h) We may only negotiate contracts on behalf of the CCG, and the CCG mayonly enter into contracts, within the statutory framework set up by the 2006Act, as amended by the 2012 Act. Such contracts shall comply with:i) The CCGs standing orders;ii) The Public Contracts Regulation 2006, any successor legislation and

any other applicable law;iii) Take into account as appropriate any applicable NHS Commissioning

Board or the Independent Regulator of NHS Foundation Trusts(Monitor) guidance that does not conflict with (ii) above.

iv) In all contracts entered into, the CCG shall endeavour to obtain bestvalue for money. The Accountable Officer shall nominate an individualwho shall oversee and manage each contract on behalf of the CCG.

8.5.4. Copies of the Procurement Strategy will be available on the CCGs website.


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9. THE CCG AS EMPLOYER

9.1. The CCG recognises that its most valuable asset is its people. It will seek toenhance their skills and experience and is committed to their development in allways relevant to the work of the CCG.

9.2. The CCG will seek to set an example of best practice as an employer and iscommitted to offering all staff equality of opportunity. It will ensure that itsemployment practices are designed to promote diversity and to treat all individualsequally.

9.3. The governing Board shall be permitted to employ or engage the services of anyindividual if it reasonably believes that the employment or engagement of such anindividual shall be of benefit to the CCG as a whole.

9.4. In the event of such employment or engagement, the Remuneration Committeeshall reasonably decide and agree the remuneration with such an individual ororganisation on a case by case basis.

9.5. The Remuneration Committee shall be permitted to reasonably decide theremuneration payable in respect of the duties undertaken by the AccountableOfficer, new direct reports to the Accountable Officer, Governing Body membersand all clinicians providing services and clinical leadership to the CCG.

9.6. The CCG will ensure that it employs suitably qualified and experienced staff whowill discharge their responsibilities in accordance with the high standards expectedof staff employed by the CCG. All staff will be made aware of this Constitution,the commissioning strategy and the relevant internal management and controlsystems which relate to their field of work.

9.7. The CCG will ensure that it complies with all aspects of employment law.

9.8. The CCG will ensure that its employees have access to such expert advice andtraining opportunities as they may require in order to exercise their responsibilitieseffectively.

9.9. The CCG will adopt a code of conduct for staff and will maintain and promote

effective 'whistleblowing' procedures to ensure that concerned staff have meansthrough which their concerns can be voiced.

9.10. Copies of this Code of Conduct, together with the other policies and proceduresoutlined in this chapter, will be available on the CCGs website.


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10. TRANSPARENCY, WAYS OF WORKING AND STANDING ORDERS

10.1. General

10.1.1. The CCG will publish this Constitution and its policies and strategies (including

communications and public patient engagement strategy), detailing any changesor updates to the document on our website.

10.1.2. The CCG will publish annually a commissioning plan and an annual report,including annual accounts which will be externally audited, presenting the CCGsannual report to one of its public meetings.

10.1.3. Key communications issued by the CCG will be published on our website,including:a) Conflicts of Interest policy;b) Register of Interestsc) Tenders and notices of procurements;d) Contract details;e) Service details;f) Policies, strategies and ways of working, including a conflicts of interest

policy, the CCGs register of interests, complaints process, communicationsstrategy and public and patient engagement strategy;

g) Performance and financial information;h) Public consultations;i) Governing Board meeting dates, times and venues;

j) Board papers and decisions;k) A Freedom of Information log, including responses to all requests.

10.1.4. The governing Board will meet in public on a monthly basis, except where it wouldnot be in the public interest in relation to all or part of a meeting. This disclaimerwill only be used in instances of commercial confidentiality or sensitivediscussions and when we receive legal advice forcing a closed session of theGoverning Body. The Governing Body meeting dates will be communicated wellin advance of the meeting date and the arrangements for public attendance clearand transparent.

10.1.5. The CCG will appoint independent lay members and non GP clinicians to the

governing Board and will actively seek to have patient views and opinionsrepresented at all levels of decision making within the CCG (where clinicallyappropriate).

10.1.6. We will disclose all information that can lawfully be disclosed and make anyrequests that were not previously available on our website accessible to all in theFreedom of Information log.

10.1.7. We may use other means of communication, including circulating information bypost, or making information available in venues or services accessible to thepublic to include local GP surgeries and local press and working our local authority

communications teams.


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10.1.8